Screenings

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Early detection is important in the fight against cancer. Finding cancer before it is advanced leads to more positive outcomes and sometimes less invasive treatments. The American Cancer Society has guidelines for when screenings should occur. Follow these guidelines or talk to your physician about starting earlier if you have a family history that may put you at a higher risk for certain cancers.

Breast Cancer

Early detection is a woman’s best defense in beating breast cancer. Regular clinical breast exams and breast self-exams should begin for women in their 20s. Mammograms should begin at age 40.

Clinical breast exams & breast self-exams

Beginning at age 20, a woman should begin to see a healthcare provider on a regular basis for a routine clinical breast exam. As part of your regular health exam, a clinical breast exam gives you and your healthcare provider time to discuss changes in your breasts and time to exchange information about breast self-exams. Breast self-exams are a systematic, step-by-step approach to looking at and feeling one’s own breasts. Paying attention to how your breasts normally look and feel can help you notice any changes that may occur.

Mammograms

A mammogram is an X-ray of your breasts. A mammogram’s goal is to detect breast cancer that is too small to be felt by you or your healthcare provider. Mammograms don’t prevent breast cancer, but they can save lives by finding breast cancer as early as possible.

During a mammogram, your breast is compressed between two plates attached to the mammogram machine. The compression helps produce a clearer image of your breast because it thins the breast tissue. The entire procedure usually takes about 20 minutes.

At IU Health Arnett, the images are captured digitally, allowing the radiologist to read the image on the computer. This allows the doctor to adjust the image size, brightness or contrast to see certain areas more closely. During the review of your mammogram, the radiologist is looking for changes in your breast, including calcifications, masses or cysts. Images are kept in your electronic medical record for your radiologist to compare from year to year.

Recommendations

The American Cancer Society recommends a screening mammogram every year for women age 40 and older for as long as they are in good health.

For women with a high risk for breast cancer, the American Cancer Society suggests getting an MRI and a mammogram every year beginning at age 30.

High risk includes those women who:

• Have a known BRCA1 or BRCA2 gene mutation
• Have a first-degree relative (mother, father, sister, brother, child) with a BRCA1 or BRCA2 gene mutation
• Have a lifetime risk of breast cancer of 20 – 25 percent or greater (according to a risk assessment performed by your doctor based on your family history)
• Had radiation therapy to the chest when she was between the ages of 10 – 30 years
• Have certain genetic diseases

For women with a moderate risk for breast cancer, the American Cancer Society suggests speaking with your healthcare provider to determine if adding an MRI to your yearly mammogram would be beneficial.

Moderately increased risk includes those women who:

• Have a lifetime risk of breast cancer of 15 – 20 percent (according to a risk assessment performed by your doctor based on your family history)
• Have had breast cancer, ductal carcinoma in situ, lobular carcinoma in situ, atypical ductal hyperplasia or atypical lobular hyperplasia
• Have extremely dense breasts or unevenly dense breasts when viewed by a mammogram

Cervical Cancer

Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up.

Pap smears are the standard test used to detect cervical cancer in women. A gynecologist or primary care physician will collect cervical cells by gently rubbing a collection device across the surface of the cervix. The cells are then sent to a laboratory for analysis.

Recommendations

Beginning at age 21 or within three years of first having sexual intercourse, whichever comes first, women should begin to get Pap smears on a yearly basis or every three years if the test is negative.

If the test is positive for abnormal cells, your physician may opt to have the test repeated within 6 – 12 months.

Colon Cancer

Early stage colorectal cancer does not usually have symptoms. In most cases, symptoms do not occur until the cancer is very advanced and very hard to treat, which is why catching it early is so important. The best method to screen for colorectal cancer is a colonoscopy.

A colonoscopy is a routine, safe and effective procedure used to visually examine the full lining of the colon and rectum for any abnormalities. A colonoscopy makes it possible to find and remove abnormal tissue growths without surgery.

During the exam, a gastroenterologist inserts a thin, flexible tube into the rectum. The tube, called a colonoscope, has a tiny video camera on the end that allows the doctors to view the inside of the entire colon.

At IU Health Arnett, all procedures are performed at the IU Health Arnett Outpatient Surgery Center in a private suite. The exam takes about 30 minutes.

Recommendations

• Schedule your first colonoscopy by age 50.
• If you are an African American, you are at a higher risk for colorectal cancer. Schedule your first colonoscopy by age 45.
• If you have a family history of colon cancer, schedule your first colonoscopy for 10 years before the age your family member had pre-cancerous polyps or cancer.
• If you had no polyps during your colonoscopy, schedule another in 10 years.
• If you had polyps during your colonoscopy, your physician will recommend another screening in one to five years.

Prostate Cancer

Recent studies about prostate-specific antigen (PSA) testing have presented conflicting information, so it’s important that you speak with your healthcare provider about the value of this critical prostate cancer screening test.

You and your healthcare provider should have a discussion of the benefits and risks of this screening, and if something abnormal is found, you need to have an additional discussion about next steps in your care plan.

PSA Screening

Prostate-specific antigen is a protein made by cells in the prostate gland. A PSA screen is a blood test that measures how much of the specific protein is found in the blood. PSA exists in both normal prostate epithelial cells and cancerous prostate cells. The prostate makes PSA all the time, so a small amount of the protein is normal. Because cancer cells produce extra PSA, a higher reading serves as warning sign.

Other possible reasons for an elevated PSA include:

• Prostate enlargement
• Prostate inflammation
• Presence of microscopic, but not clinically significant, cancer

Healthcare providers also recommend a digital rectal exam (DRE) during your routine medical exam as an additional screening for prostate cancer.

Early prostate cancer usually has no symptoms and is most often found by a PSA test or DRE. Your healthcare provider will monitor your PSA levels over time to determine the development of prostate cancer.

Recommendations

• Your healthcare provider may recommend a baseline PSA screen in your 40s. He or she will use this level to monitor changes over time.
• PSA screening may begin by age 50.
• African-American men are at a higher risk; you may begin PSA screening by age 45.
• For men who have a family history of prostate cancer, you may begin PSA screening by age 40.
• Men with a normal PSA level should be retested every two years.
• Men with a high PSA level should be tested annually.

Should your PSA levels rise, your healthcare provider may recommend a biopsy for further testing. If prostate cancer is found, a discussion with your healthcare provider should cover the benefits and risks of treatment options. Some prostate cancers detected in certain men may not need immediate treatment. Active surveillance through PSA screening allows your healthcare provider to treat the cancer when the disease appears to become more aggressive or is growing.

Skin Cancer

Skin cancer screenings are an important part of prevention and treatment. Though the incidence of skin cancer is increasing across the nation, if caught early it is one of the most treatable forms of cancer. Your physician or a dermatologist will perform a skin assessment. Physicians will check for a variety of signs of skin cancer during the assessment.

Moles are checked for several suspicious characteristics:

• Asymmetry—where one half of a mole does not resemble the other
• Border—irregularity where the edges of a mole are ragged and not uniform
• Color—pigmentation is not uniform, shades of tan, brown and black are present and the appearance of the mole may be mottled
• Diameter—the mole or skin growth is larger than 6 millimeters or about the size of a pencil eraser
• Evolving—a mole that is changing in any way

Other signs doctors look for:

• Oozing, bleeding or scaling
• Redness or irritation in the skin
• Tingling, itching or burning around the mole
• Brittleness or small pieces of the mole breaking off

Based on this assessment, it will be determined whether you need a biopsy. A biopsy may be done that day or you may be asked to return in one to two weeks to see one of the surgeons for an excisional biopsy.

Recommendations

Though there are no official recommendations for skin cancer screenings, those who are fair-skinned, who are 65 and older, have atypical moles or have over 50 moles are at higher risk for melanoma. People in this higher risk category should perform skin examinations on their own on a regular basis and report any changes to their physicians.